Achilles tendon injuries rank among the most common overuse injuries in athletes. These injuries can range from simple tendonitis to complete rupture.

Anatomy

Comprised of the two conjoined tendons of the soleus and gastrocnemius muscles, the Achilles tendon inserts into the rear part of the heel bone. The bulk of the soleus fibres insert into the inside aspect of the heel bone. Surrounding both tendons is an extremely important vascular sheath, called the peritenon, which nourishes the tendon fibres with its blood supply. Because of the specific insertion of these individual tendon fibres, athletes with a tendency to pronate (e.g. become flat-footed) repeatedly stretch the soleus tendon, increasing the likelihood of injury. Athletes with high-arched, supinated foot types constantly stretch the gastrocnemius fibres, causing injuries higher up the Achilles tendon.

Mechanism of Injury

Simple irritation from improper footwear can lead to a mild burning or prickly heat sensation in the Achilles tendon about 1 to 3 inches above the heel bone. Shooting or stabbing pain during physical activity, especially after a sudden change in direction or while running uphill may indicate an inflammatory tendonitis. In the case of partial or complete rupture of the tendon, there may be a snap or pop, with or without pain. A great deal of swelling will develop, and there will be significant weakness, making it difficult to push off or raise the heel up.

Treatment

Prevention with a solid pre-conditioning program is the best treatment. Proper stretching of both the soleus and gastrocnemius muscles is advised. Plyometric drills can help to coordinate muscle reflexes to react to sudden changes in direction. Don’t hesitate to seek professional help. Physiotherapy using ultrasound and interferential current can help with control of pain and inflammation. Education about proper stretching and strengthening exercises and avoidance of contributing factors is also important. In complete ruptures, surgical repair of the tendon is necessary followed by several weeks of immobilization. Rehabilitation lasting several months will then be required in order to be able to return to running.

Reference: Conquering Athletic Injuries, Paul M. Taylor & Diane K. Taylor